Califonia
In Califonia, the jurisdiction of the Califonia Board of Registered Nursing governs and ensures that advanced practice nurses (APN) have satisfied prior requirements for licensure, accreditation, certification and educations. It is a requirement that to be licensed and accredited as advanced practice nurse in Califonia, one must also meet prerequisites for a registered nurse.
A certified nurse practitioner ought to first attain a minimum master’s degree in the field of advanced nursing practice. The institution attended should have the necessary accreditation by the National League of Nursing or any other recognized accreditation agency. The Califonia Board of Registered Nursing should have approved the school’s program to validate that they comply with the states regulations and statues ( Nursinglicensure.org, n.d) . The graduate program must satiate the Califonia Board standards as postulated in section 1484 of the Califonia code regulations. To be licensed as a certified nurse practitioner (CNP), the licensing agency requests a documentation of the pursed course content. As a certification and accreditation requirement, the board has to confirm that the program studied features in the list of approved Califonia programs (ANCC, n.d). For certification as a CNP in Califonia, a nurse must meet verification prerequisites of clinical proficiency and competency in primary care services provision and clinical experience. A licenced physician and a nurse practitioner who ought to be licenced also, verifies the clinical competency of a certified nurse practitioner prior to certification by approved certification agencies (Blair & Jansen, 2015). Examples of approved certification agencies include American Academy of Nurse Practitioners, American Nurses Credentialing Center among others.
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Certified Nurse Midwife LACE requirements requires a nurse to demonstrate qualification for accreditation, certification and licensure by satisfactorily completing a nurse midwife program that is pre-approved. The applying nurse ought to have pursued an additional program that satisfies threshold standards as indicated in Califonia 1462 state regulation. Certification can also be achieved through verification performed by the American Midwifery Certification Board. The nurse should have studied and completed approved nurse midwife programs (Brown, 2008). A nurse is also required to submit a recency form as a verification of clinical experience for the past 5 years.
LACE requirements for certified registered nurse anaesthetist (CRNA), include completion of an education program such as Anaesthesiology. The Council on Accreditation of Nurse Anesthesia Education Programs ought to have approved the completed program. Upon completing an approved course, the nurse should seek certification from Recertification of Nurse Anesthetists Board.
To satisfy LACE requirements as Clinical Nurse Specialist (CNS), a nurse must first pursue a master’s degree in the respective clinical nursing specialty that fulfils Board standards. A verification of clinical experience and prior education is a mandatory prerequisite. Verification of prior clinical experience is undertaken by a professional who ought to be conversant with the clinical nurse specialist role (Brown, 2008). As a requirement, the nurse who is seeking licensing, accreditation and certification must competently execute the five advanced nursing component areas. The five include expert clinical nursing practice, education, clinical leadership, consultation and research. As Furlong and Smith (2005) assert, it is paramount for the nurse to present documents showing that he or she completed the five component areas in the coursework. Prior clinical experience is also necessary. To acquire certification, a nurse is required to hold credentials accorded by American Nurses Credentialing Center.
Washington
To fulfil LACE requirements for Clinical Nurse Specialist in the state of Washington, a nurse should first complete master’s program or higher degree in the specialty selection. Course requirements include 2 to 3 years of study and 30 to 40 graduate nursing credits. A practicum or internship is a preliminary to fulfill education requirements (Dowling, Beauchesne, Farrelly & Murphy, 2013). To earn certification as a (CNS), a nurse is required to register, sit and pass specialty exam offered through American Nurses Credentialing Center. Licensure puts a mandatory requirements for a nurse to pass the certification exam. Since Washington is not a member to the nurse license compact, the state does not licence clinical nurse specialists unlike Califonia and Illinois.
To meet LACE requirements as a Certified Nurse Practitioner in Washington, a nurse ought to have successfully completed an advanced nursing course one year before application for a permit to practice as a CNP. An accreditation agency governed by the United States Department of Education should have approved the studied nursing program (Mateo & Foreman, 2013). If a nurse earned the degree outside the United States, the completed program ought to be approved by the Washington State Department of Health as an equivalent to the advanced registered nurse program. Licensure for prescriptive authority requires a nurse to compete 30 contact hours in a program specific to the scope of practice (Dowling et al., 2013). Certification requires a nurse to sit and pass a competency based examination pertaining the area of specialty. The certification program should be approved by the American Board of Nursing. Dunn (2017) explain that requirements for licensure in Washington include a license application which must provide a US social security number. Additional licensure requirements include official transcripts, proof of having no fewer than 250 hours of practice and evidence of holding national certification.
Competing an accredited master’s program or higher degree in nurse-midwifery is one of the education requirements in Washington for CNM. One should have a bachelor’s degree in Nursing (BSN) and possess unencumbered RN license to satisfy education prerequisites. Upon completing the advanced program in midwifery, a nurse should take and pass the Nurse-Midwifery National Certification Examination offered by the American Midwifery Certification Board (Zorek & Raehl, 2013). Candidates ought to make an application with appropriate certifying agency prior to scheduling an exam. The nurse should take the certification exam through Applied Measurement Professionals body centers situated in various areas across Washington. Upon accreditation and certification, the nurse should make Advanced Registered Nurse Practitioner application to the Washington Quality Care Commission for licensure. Additional Licensure requirements include official college transcripts, pharmacology education and proof of current national certification.
To meet LACE requirements as a Registered Nurse Anaesthetist, one is required to earn masters of Science or higher degree in Nurse Anesthesia. To fulfil education requirements, advanced programs should be accredited by the Nurse Anesthesia Council on Accreditation. Programs should range between 24 to 36 months consisting of coursework and clinical components (Dunn, 2017). To earn a certification, the nurse should successfully pass the National Certification Examination offered by the Recertification for Nurse Anesthetists Board. Washington requires nurses seeking licensure to provide proof of earning CRNA certification and verification that one has completed an approved nurse anaesthesia program (Hamric et al., 2013). Washington requires its nurses to submit a prescriptive authority application coupled with physician supervision form.
Illinois
In Illinois, the four APN roles: CNP, CNM, CRNA and CNS, are governed by the Illinois Department of Financial and Professional Regulation. The advanced practice nurse in the four specialities should have RN and APN licensing.
To fulfill the Certified Nurse Practitioner in Illinois, one ought to complete an advanced nurse practitioner program in Illinois in an accredited institution recognized by the United States Education Department. Nurse- Midwife, Nurse Anesthetists and Clinical Nurse specialists must also pursue an advanced program in respective approved specialties ( Smolenski, 2005) . Certification in the four nursing roles in Illinois requires a nurse to sit and pass an exam based certification. To earn a certification as a nurse anesthetist, one should pass an examination offered by the American Association Nurse Anesthetists Council. Nurse Midwifery candidates should also apply, sit and pass a certification paper by the American Midwifery Certification Board. To earn certification and accreditation as a certified nurse practitioner, one should pass professional certification exam by the American Academy of Nurse Practitioners or American Nurses Credentialing Center. For clinical nurse specialist in Illinois, a certification exam is offered by Rehabilitation Nursing Certification Board, American Association of Critical Care Nurses amonth others ( Ketefian et al., 2001) . To satisfy licencing requirements, the nurses in the four roles should provide documentation from the certifying board and sit for licensing examination. Additional licensing requirements include graduate transcripts and a qualifying certification copy. Unlike in other states, Illinois requires the APNs to showcase possession of collaborative agreements to be granted prescriptive authority.
From the analysis one difference that manifests between the three states LACE requirements include the agencies that regulate the APNs. In Washington for example the Nursing Care Quality Assurance Commission regulates the ARPNs while in Califonia APN are governed by the Califonia board of Registered Nursing. The three states also differ in the prescriptive privileges since each of them have different fee and applications requirements (Hamric, Spross & Hanson, 2000)
Evidenced-based strategies to implement to achieve continuity among all 50 states for APN practice
Over years, continuity and steadiness among states has been weak for APN practice due to utilization of different laws for advanced practice. The following delineates evidence based practices which if implemented would be vital in reinforcing continuity between state regulatory boards.
Full Practice Authority
The evidence based strategy exhorts the need to consolidate state practices and license laws to undertake activities such as assessing patients, instructing, managing treatments and explaining diagnostic tests through a single license authority of the Nursing State Board. Full practice authority should be adapted uniformly among all states to give independence for APN practice (Spector, 2010). If fully adapted, the 50 states would achieve continuity of care between state regulatory boards.
Adopting Advanced Practice Registered Nurses Consensus model
The model is a form of evidence based strategy that proposes adoption of extensive efforts by the APRN committee of National Council of States Boards of Nursing and Consensus group. The regulation model advocates for integration of four roles with one of them focussed on education to the nursing practitioners as an endeavour to address population element such as neonatal care, adult-gerontology and mental health (Spector, 2010). Implementation of the APRN consensus model as evidence based strategy should occur at the federal stage to promote realization of continuity between state regulatory boards.
Utilization of Disciplined Clinical Inquiry model
The framework can be adopted as an evidence based strategy in ensuring continuity. Through DCI model, evidence based care across all states would be integrated into organizational and individual performance. The framework has a central focus on assessing nursing attitudes, engaging nurses in learning and evaluating patient’s receipt of nursing interventions (Andrew Scanlon et al., 2014). The strategy achieves continuity through engaging nurses in all states in an ongoing evaluation of outcomes and processes.
Benchmarking
The evidence based strategy can be utilized in regulating state boards to achieve continuity through measuring performance outcomes. According to Spector (2010), state regulatory boards can adopt the strategy in improvement of nursing care, nurse’s skills and in ensuring effective individualized care interventions for APN practice.
Current NP practice in Florida and Personal Opinion
In Florida, nurse practitioners with active licenses are required to practice under the close supervision of osteopathic physicians and or medical doctors. Nurse practitioners have a limitation in their abilities to offer care (Bahadori & Fitzpatrick, 2009). The law requires NP to secure collaborative agreements with physicians and doctor approvals prior to ordering basic diagnostic tests. As Hain and Fleck (2014) explain, NP in Florida must seek physician supervision and approvals when taking responsibilities even if they are fully equipped to carry out the medical tasks. Florida requires NP to maintain supervision agreements hence overly restricting their ability to practice.
In my opinion, NP ought to be autonomous in their practice. Restriction to operate under supervision agreements should be lifted since NP have the necessary competencies to offer safe, cost effective and high quality healthcare whose standards are equivalent to those of physicians. The NP are equipped with requisite training, education and credentials to offer exceptional care, which is a sufficient justification for NP be allowed to practice independently. I hold the view that the limitation rules do not serve any purpose. A legislation should be passed abolishing the restrictions imposed on the NP autonomy to allow them practice independently.
References
Andrew Scanlon, D. N. P., Denise Hibbert, R. G. N., Freda DeKeyser Ganz PhD, R. N., Linda East PhD, R. N., & Debbie Fraser MN, R. N. (2014). Addressing issues impacting advanced nursing practice worldwide. Online journal of issues in nursing , 19 (2), 1.
American Nursing Credentialing Center (ANCC) (n.d). Certification general testing and renewal Handbook, https://www.nursingworld.org/~4a8596/globalassets/certification/renewals/GeneralTestingandRenewalHandbook .
Bahadori, A., & Fitzpatrick, J. J. (2009). Level of autonomy of primary care nurse practitioners. Journal of the American Academy of Nurse Practitioners , 21 (9), 513-519.
Blair, K. A., & Jansen, M. P. (Eds.). (2015). advanced practice nursing: Core concepts for professional role development . Springer Publishing Company.
Brown, S. J. (2008). A framework for advanced practice nursing. Journal of Professional nursing , 14 (3), 157-164.
Nursinglicensure.org (n.d). Advanced Practice Nurse Requirements in California, https://www.nursinglicensure.org/np-state/california-nurse-practitioner.html
Dowling, M., Beauchesne, M., Farrelly, F., & Murphy, K. (2013). Advanced practice nursing: a concept analysis. International Journal of Nursing Practice , 19 (2), 131-140.
Dunn, L. (2017). A literature review of advanced clinical nursing practice in the United States of America. Journal of Advanced Nursing , 25 (4), 814-819.
Furlong, E., & Smith, R. (2005). Advanced nursing practice: policy, education and role development. Journal of clinical nursing , 14 (9), 1059-1066.
Mateo, M. A., & Foreman, M. D. (Eds.). (2013). Research for advanced practice nurses: From evidence to practice . Springer Publishing Company.
Hamric, A. B., Hanson, C. M., Tracy, M. F., & O'Grady, E. T. (2013). Advanced Practice Nursing-E-Book: An Integrative Approach . Elsevier Health Sciences.
Hain, D., & Fleck, L. (2014). Barriers to nurse practitioner practice that impact healthcare redesign. OJIN: The Online Journal of Issues in Nursing , 19 (2).
Hamric, A. B., Spross, J. A., & Hanson, C. M. (2000). Advanced nursing practice: An integrative approach . WB Saunders Company.
Ketefian, S., Redman, R. W., Hanucharurnkul, S., Masterson, A., & Neves, E. P. (2001). The development of advanced practice roles: implications in the international nursing community. International nursing review , 48 (3), 152-163.
Spector, N. (2010). Evidence-based nursing regulation: A challenge for regulators. Journal of Nursing Regulation , 1 (1), 30-36.
Smolenski, M. C. (2005). Credentialing, certification, and competence: Issues for new and seasoned nurse practitioners. Journal of the American Association of Nurse Practitioners , 17 (6), 201.
Zorek, J., & Raehl, C. (2013). Interprofessional education accreditation standards in the USA: a comparative analysis. Journal of Interprofessional Care , 27 (2), 123-130.
